Oral Health Inequalities

Abstract

Recent research has emphasized the relationships between environmental and individual factors that may influence population oral health and lead to health inequalities. However, little is known about the effect of interactions between environmental and individual factors on inequalities in clinical (e.g., decayed teeth) and subjective oral health outcomes (e.g., oral health-related quality of life [OHQoL]). This cohort study aimed to explore the direct and mediated longitudinal interrelationships between key environmental and individual factors on clinical and subjective oral health outcomes in adults. Self-reported measures of OHQoL and individual (sense of coherence [SOC], social support, stress, oral health beliefs, dental behaviors, and subjective socioeconomic status [SES]) and environmental factors (SES and social network) were collected at baseline and 3-mo follow-up, together with a baseline clinical examination of 495 adult employees of an automobile parts manufacturer in India. Lagged structural equation modeling was guided by the adapted Wilson and Cleary/Brunner and Marmot model linking clinical, individual, and environmental variables to quality of life. The study provides tentative evidence that SES may influence levels of resources such as social support and SOC, which mediate stress and in turn may influence subjective oral health outcomes. Accordingly, the present findings and the adapted Wilson and Cleary/Brunner and Marmot model on which they are predicted provide support for the psychosocial pathway being key in the SES-oral health relationship. The pathways through which environmental factors interact with individual factors to impact subjective oral health outcomes identified here may bring opportunities for more targeted oral health promotion strategies.

Periodontitis and quality of life: What is the role of socioeconomic status, sense of coherence, dental service use and oral health practices? An exploratory theory‐guided analysis on a Norwegian population

“…SOC was the main predictive factor for oral healthrelated impacts, where a stronger sense of coherence decreased the likelihood of having oral health impacts. This is in line with results from previous studies (Gupta et al, 2015;Savolainen et al, 2005).…”

“…Following specification of the measurement model, the next step in the analysis was to test a structural model which examined the direct and indirect relationships between the constructs as hypothesised in our revised Andersen's behavioural model for health services' use. In accordance with the model and with SOC as an additional predisposing factor based on findings fromGupta et al (2015), 24 direct pathways were hypothesised. Population characteristics: social structures and SOC (higher scores) would predict more en-SOC, enabling resources, treatment need and use of dental services would predict periodontal health, which in turn would predict oral impacts, with more severe periodontitis relating to more oral impacts.…”

“…Sense of coherence (SOC) is a salutogenic concept and "a specific way of viewing life as comprehensible, manageable and meaningful" (Antonovsky, 1987). It has been found to be important for adults' oral health in several recent studies including toothbrushing habits, eating fruit and vegetables, dental attendance, and oral healthrelated quality of life (Elyasi et al, 2015;Gupta, Robinson, Marya, & Baker, 2015;Savolainen et al, 2005).…”

Impact of sense of coherence on oral health-related quality of life among Brazilian adults

“…7,8 In fact, a high SOC is usually associated with the adoption of healthy oral health-related behaviors, which would change the clinical state of the individual, and his subjective interpretation of the importance of oral health. 9,10,11 The influence of SOC on OHRQoL impacts was assessed in a study on a representative sample of the Finnish population, 12 whereby an association of the SOC with all dimensions of the OHIP was found, especially psychological discomfort, psychological incapacity and handicap. The authors of the study found that a low SOC would lead to a high impact on OHRQoL, regardless of oral health conditions, healthy behaviors or socioeconomic factors.…”

Improving oral healthcare: towards measurement?

“…Moreover, when using data and measures to compare practice, it is important to consider socio-economic and demographic determinants of health. 15,16 Data and measures should be used judiciously, avoiding normative approaches. In particular, they should be used to inform conversations on the one hand between oral health professionals on provided care and on the other hand between oral health professionals and patients.…”